proximal patella realignment- questions regarding recovery

[shannen]

Hi....

I had a proximal patella realignment about 6 weeks ago. I have had several knee surgeries the past few years (partial tear, then later full tear with both ACL's. First reconstruction with my patella tendon, the other reconstruction with a cadavor tendon) and was completely suprised as to how difficult the recovery from this surgery has been. I was hoping someone could share their recovery experience especially as it pertains to the following questions.

1.) I have been having a really hard time getting my range of motion back. Is this typical with this surgery (I have been in a brace and only allowed 0-30 the first 2 weeks, then 0-60 the second two weeks, and finally 0-90 the third two weeks)? My brace is currently set at 90 degrees but I have been stuck at 65 degrees for the past week and a half. I am not working this summer and so I have been spending about 2-3 hours per day (in addition to PT 3 days a week) working on ROM. It is frustrating to spend this much time and to see such little progress.

2.) My knee still looks swollen and is about 2-3 times as big as the other knee. How long does it usually take for the swelling to go down?

3.) Are there any particular exercises that have helped you get ROM back and/or decrease scar tissue?

Thank you so much....My recovery with my previous surgeries was pretty quick, and I never had ROM issues.
Shannen

[Kris]

I had a proximal reallignment in May of 2005. It isn't a quick recovery from it. I was locked in a brace and on crutches for about 4 weeks. Afterwards I was allowed to increase the brace up to 90 degrees, one notch each week until I got to the 90 degrees. At therapy I wasn't allowed to bend the knee past that 90 degree mark for quite a long time. I was actually on crutches from May until mid-July and still using one crutch at the beginning of August.

As for therapy, the bike really helped me get my range of motion. I had a high seat and would pedal backwards instead of forwards for a while. I also did a lot of heel slides against the wall. I'd lay on the ground and place my foot/leg up against the and let gravity help me bring it down. I used the other leg to help guide it and to help lower it. Be patient. It'll take awhile for the ROM to come back, but it will. My therapist were instructed by the doc to never force the motion until he gave the order. I think this helped a lot too.

Good luck and if you ahve any other questions just ask. I think overall the reallignment worked, but the damage was already too severe to help with the underside of the kneecap. The surgery at least put the kneecap back on track.

Kris

[pattiann]

Dear Kris and Shannen. I just had the same procedure done to my left knee on the 6th of Dec. 2006. I am 47 yrs old and was very active at my job. I work in a gym. I did spin classes and areobics 3 to 4 times a week. I only had the surgery because I wiped out on the dance floor when my knee dislocated. I had the problem since I was 12. I was told this would stop it from dislocating, but was not told how long I would go without ROM. I cannot lift my leg at all. My PT has me doing some excericises to try to bend it further but the knee cap is so hard from scar tissue that I need to keep massaging it. It feels like my knee is going to rip if I try to bend it any further. My PT puts me in that machine that bends your knee for you. Very scary! I always feel it is going to go hay wire. Lets keep in touch with our progress. I need to get some movement back for a trip to Florida in March. My son is in the parade. Do I rent a jazzy or do you think I should be able to walk a little? I felt alone there for awhile. Did you?

[Kris]

Pattiann,

You are still early in your rehab. I wasn't allowed to start rehab until almost 2 months after surgery and then my therapist was given strict instructions for only passive motions which mean no forcing the knee to bend. I was also only allowed to bend it to 90 degrees in therapy. The good news is that for me by the time I started teaching school again in mid-August. I was walking (a little limpy), but I was moving and able to teach. I had all range of motion and little to no limp at about December of that year.

Kris

[RMancini]

Shannen:

I hope your recovery continues to progress well.

I will watch for updates on your recovery. I am about to have a TTT/Fulkerson at end of Jan '07. These boards are a huge help to folks like me who are looking at a TTT and wondering what to expect. No matter how you slice it, I guess, recovery is going to demand all the patience and determination one has.

Am doing a lot of pre-surgery physical therapy now in the expectation that adding strength to the knee and getting the joint in the best possible shape will help in recovery and in PT. I hope it helps. It feels good, so it must be doing some good.

Feels really good to know that so many others have been through this. My story is much like PattiAnn's. Age:46. Left knee.

[amy1]

I had a proximal realignment (medial plication, lateral release) 10 days ago. I went home in an imobilizer. My first post op check (two days later) went fine, but that evening I started bleeding from the incision. There was enough blood to saturate the dressing so the doctor had me come to the ER that evening. They ran blood work and admitted me. Early the next morning, the doctor came by and said that my sed rate was very high. It could either be just my bodies reaction to surgery or a sign of infection. He thought that the bleeding was either a hemotoma or bleeder that was missed. Later that morning, he went back in to see what was going on. The doctor said that there were no bleeders so he feels that the bleeding was caused by a hemotoma. He washed out the joint and cultured the fluid to determine whether or not I had an infection. I was started on antibiotics that morning as a precaution. The doctor kept me in the hospital that evening also to monitor the incision and also monitor blood work and the culture. I went back to the doctor 5days after the second surgery and the culture was still negative for infection. I was in the imobilizer for a few days. I started the CPM machine the day after I got home from the hospital and was allowed to weight bare as tolerated. Right now, the cpm machine is set to go from zero to 70. I am able to sit at the computer with my knee at about 90 degrees without pushing it at all. I am starting pt tomorrow. I am now able to stand in the shower and to brush my teeth but use a crutch when I walk from room to room. My knee is kind of stiff and angry right now, but then again it is very swollen and I have those lovely staples going down the middle of my knee. I am definitely uncomfortable but only had to take pain killers once today. Unfortunately, five days after the surgery, I fell big time using the crutches. It turned out that I have a hairline fracture at the head of the radial bone, the bone that inserts into the elbow. The hand, upper extremetiy specialist who is treating me for my elbow dosn't want me to use the broken elbow side for weight bearing which means that I am only able to use one crutch. Right now, I feel like a 90 year old woman. When I get up from the chair, I have to just stand a few seconds before starting to walk ....how strange it feels. In a mut shell, so far range of movement does not appear to be a real problem. I figure that if I could get 90 degrees without really pushing it when I still have staples in my knee and a good deal of swelling, that is not bad. The main thing that I notice is that my knee is stiff, sort of buckles sometimes and I get lot of weird twinges in my knee. I guess that it is way to soon to start being concerned about those things though.

I find it amazing how different each doctor's post op protocols are. The other people in this thread seem to indicate that they were in locked braces for a few weeks post op. My doctor had me in the CPM machine 24 hours post op and had me using the imobiziler for a few days post op as needed for comfort. He encouraged me to move my knee, especially when just laying and wathching TV to preserve range of motion.

[Kris]

It is amazing how surgeries differ. I didn't use a CPM after this surgery, but after my microfracture surgery I was using it for 6-8 weeks and at least 6 hours a day. I was also non weight bearing for that time as well and no therapy 7 months later. Others have started therapy right away and have been weight bearing. He said he's using caution because of my multiple other knee surgeries and just going slow with me. I start Synvisc (4 or 5 round) a week from today. I used to know what our path was going to be with this knee, but now it's all a surprise to me.

Kris